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NIHR Signal Tranexamic acid is safe to use following mild-to-moderate traumatic brain injury and reduces deaths
In people with mild-to-moderate traumatic brain injury, tranexamic acid (a drug which reduces bleeding) given within three hours of injury reduces the risk of death by 22%. This effect is seen in a subgroup of those who are less severely affected. This NIHR-funded multi-centre international trial randomised 12,737 adults with intracranial bleeding to receive either tranexamic acid or a placebo. Overall, there was no difference in risk of death within 28 days between the two groups. However, whe...
NIHR Signal Twenty mph speed zones reduce the danger to pedestrians and cyclists
Introducing 20mph speed zones reduces road traffic accidents, including those suffered by pedestrians and cyclists. Speed zones use physical obstacles such as road narrowing, speed bumps and chicanes, whereas speed limits only use signs and lines. The evidence was inconclusive on whether limiting speed to 20mph alone was effective, without the traffic calming. There was scant evidence on whether either speed reduction intervention was linked to increased activity such as walking or cycling. Th...
NIHR Signal A lower drink-drive limit in Scotland is not linked to reduced road traffic accidents as expected
Lowering the drink-drive blood alcohol limit in Scotland was not followed by reduced road traffic accidents, perhaps because of a lack of enforcement. While there was a 0.7% reduction in alcohol bought in pubs and restaurants after the new legislation (on-trade sales), there was no significant change in sales of alcohol from shops or supermarkets (off-trade), where most purchases are made. Drink-drive accidents account for around 13% of all road deaths in Britain. In an attempt to improve this ...
NIHR Signal A temporary clot-catching filter inserted after major trauma does not prevent lung clots
In adults after major trauma who cannot safely be given anti-clotting drugs, placing a removable metal filter in a major vein to the heart (the inferior vena cava) within 3 days of admission does not reduce their chances of having a clot in their lungs (pulmonary embolus) within 90 days, compared with having no filter. The filters do not affect the risk of bleeding. The filter aims to catch clots that might develop in the legs and travel to the lungs, until anti-clotting drugs can be safely sta...
NIHR Signal Non-invasive brain stimulation may improve outcomes for children with brain injury
Non-invasive brain stimulation may help improve limb function in children with motor disorders following brain injury, such as cerebral palsy or one-sided weakness. This is a relatively safe procedure where pads placed on the head deliver electric or magnetic currents, which are thought to activate the motor areas of the brain. This review evaluated 14 trials, including 306 children comparing two types of brain stimulation with a control group. It found that these types of stimulation may impro...
NIHR Signal An ultrasound scan is not as useful as a CT scan in assessing trauma
Ultrasound scans can be a useful tool to help pinpoint internal bleeding or organ damage in the chest or abdomen, but a negative scan cannot rule out damage, especially in children. Many emergency departments use portable ultrasound scanners to assess for internal damage when someone has been subject to blunt trauma (for example, involved in a car accident or fallen from a height). Ultrasound is free from radiation, non-invasive and can be used at the bedside, making it convenient if CT is not ...
NIHR Signal A new tool helps predict recovery from ankle sprain
The SPRAINED model may improve prediction of people who are at risk of delayed recovery from ankle sprain. This model was developed in the UK using clinical information from 584 adults with ankle injuries. The model was validated using observational data from 682 people with ankle sprains across 10 different UK emergency departments. Delayed recovery from ankle injury was more likely to be detected when using the SPRAINED model than by clinicians using judgment alone. Re-assessing pain levels ...
NIHR Signal Early cooling provides no benefit following traumatic brain injury
Deliberate cooling (prophylactic hypothermia) in the early management of traumatic brain injury does not improve neurological outcomes at six months. Inducing hypothermia may also increase the risk of pneumonia. Hypothermia (33-35oC) is sometimes induced to try and limit brain damage in people with severe head injuries. However, evidence for its safety and effectiveness has been mixed. A 2015 trial (Eurotherm 3235) found that therapeutic hypothermia, for adults with raised intracranial pressur...
NIHR Signal Negative pressure dressings are no better than standard dressings for open fractures
Negative pressure wound dressings are neither more nor less effective than standard wound dressings for severe open fractures of the lower leg. Any difference between groups was neither clinically important nor statistically significant. The outcomes included self-rated disability at one year, quality of life and deep surgical site infections at one month which occurred in around 7-8% in each group. Open fractures of the leg, where the broken bone is exposed by the original injury or has burst ...
NIHR Signal Early, intense rehabilitation helps recovery after serious traumatic head injury
Early, intensive rehabilitation aids recovery and improves outcomes for people with moderate to severe traumatic brain injury. A review of 11 studies found that starting rehabilitation early, while people were still in intensive care, or offering more intensive treatments helped patients with brain injury regain function compared with usual care. Early rehabilitation often included multisensory stimulation while the patient was still in a coma. The intensive multidisciplinary programmes mostly ...
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